BEXAR COUNTY MEDICAL EXAMINER S OFFICE 2008 ANNUAL REPORT 7337 LOUIS PASTEUR DRIVE SAN ANTONIO, TEXAS 78229 (210) 335-4000
Prepared by: Wanda S. Austin Office Assistant IV Bexar County Medical Examiner's Office (210) 335-4053 austin@bexar.org
TABLE OF CONTENTS Medical Examiners and Section Supervisors... Organizational Chart... Organization and Duties... General Statistics... Cases Investigated Cases Accepted Cases Autopsied/Inspected Unidentified Bodies Donations (Organ, Corneal and Tissue) County Burials Cremation and Burial Transit Permits Issued Toxicology Tests Performed Explanation of Data and Abbreviations Used... Manner of Death... Percent Autopsied Homicides By Method... By Age, Race/Sex... By Firearms... Drugs/Alcohol in Victim... Child Homicides... Sudden Unexpected Death In Infancy... Suicides By Method, Age, Race/Sex... By Firearms... Drugs/Alcohol in Victim... Teenage Suicides By Method, Race/Sex... Accidents By Method... By Age and Method... Drugs/Alcohol in:... Drivers... Pedestrians... Motorcyclists/Bicyclists... Deaths Due To Drugs/Toxic Substances... Fee Schedule... 2 3 4 5 6 7 8 9 10 11 12 12 13 14 15 16 17 18 19 20 21 22 23 1
MEDICAL EXAMINERS Randall E. Frost, M.D. Chief Medical Examiner D. Kimberley Molina, M.D. Deputy Chief Medical Examiner Jennifer J. Rulon, M.D. Rajesh P. Kannan, M.D. Elizabeth A. Peacock, M.D. Medical Examiner Medical Examiner Medical Examiner SECTION SUPERVISORS Gloria Delgado Administrative Supervisor J. Rod McCutcheon Chief Toxicologist James R. Holguin Chief Medical Investigator Martin Castillo Chief Autopsy Technician 2
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ORGANIZATION The Bexar County Medical Examiner's Office has four major sections: the Investigative; the Medical; the Administrative; and the Toxicologic. Total staff positions in 2008 were 44. The M.E. Staff consists of twelve Investigators; five Forensic Pathologists; a Fellow (an individual training as a forensic pathologist); nine Toxicologists; five Autopsy Technicians; five Morgue Attendants; and seven clerical support personnel. DUTIES The BCMEO is charged, by State law, with investigating the following type of deaths: 1. When a person shall die within twenty-four hours after admission to a hospital or institution or in prison or in jail; 2. When any person is killed; or from any cause dies an unnatural death, except under sentence of the law; or dies in the absence of one or more good witnesses; 3. When the body or a body part of a person is found, the cause or circumstances of death are unknown, and: (A) the person is identified; or (B) the person is unidentified; 4. When the circumstances of the death of any person are such as to lead to suspicion that he came to his death by unlawful means; 5. When any person commits suicide, or the circumstances of his death are such as to lead to suspicion that he committed suicide; 6. When a person dies without having been attended by a duly licensed and practicing physician, and the local health officer or registrar required to report the cause of death under Section 193.005, Health and Safety Code, does not know the cause of death. The BCMEO works with law enforcement agencies in Bexar County and approximately 32 other counties for which the BCMEO provides autopsy services, as well as State and Federal agencies. In addition, it works with the District Attorneys in these areas. The total budget for this Fiscal year was $4,130,932.00 When the local health officer or registrar of vital statistics whose duty it is to certify the cause of death does not know the cause of death, he shall so notify the medical examiner of the county in which the death occurred and request an inquest; 7. When the person is a child who is younger than six years of age and the death is reported under Chapter 264, Family Code; and 8. When a person dies who has been attended immediately preceding his death by a duly licensed and practicing physician or physicians, and such physician or physicians are not certain as to the cause of death and are unable to certify with certainty the cause of death as required by Section 193.004, Health and Safety Code. In case of such uncertainty the attending physician or physicians, or the superintendent or general manager of the hospital or institution in which the deceased shall have died, shall so report to the medical examiner of the county in which the death occurred, and request an inquest. The Medical Examiners certify the cause and manner of death in all cases in which they accept jurisdiction, performing autopsies, when necessary, to make such determinations. In 2008, the Office investigated 9,500 deaths, accepted jurisdiction in 2,273, and performed 1,431 autopsies and approximately 63,358 toxicology tests. 4
GENERAL STATISTICS 2006 2007 2008 Total Number of Cases Investigated 9244 9304 9500 Cases Accepted 2255 2370 2273 Scene Investigations 580 648 772 Bexar County 2022 2242 2192 Autopsies Complete Autopsies 1104 1230 1227 Partial Autopsies 149 154 124 Inspections 590 673 678 Death Certificates Only 51 45 38 Storage/Voided Cases 128 140 125 1 Contract Cases (Out of County) 233 128 81 Autopsies Complete Autopsies 219 118 76 Partial Autopsies 9 5 4 Inspections 5 5 1 Total Autopsies Complete Autopsies 1323 1348 1303 Partial Autopsies 158 159 128 Inspections 595 678 679 Hospital Deaths 7 11 15 Unidentified Bodies 4 5 5 Exhumations 0 0 0 Bodies Transported 1934 2164 2106 Donations Organ N/A N/A 33 Corneal N/A N/A 200 Tissue N/A N/A 156 County Burials N/A N/A 49 Cremation Certificates Issued 3302 3400 3846 Burial Transit Permits Issued 3515 3598 3981 Autopsy Reports Requested 3322 3047 2721 Toxicology Tests Performed 61918 58945 63358 1 Contract cases (Out of County) are reported on this page for the purpose of performance indicators. For County statistical purposes, only Bexar County cases will be reported for the remainder of the annual report. 5
Explanation of Data The following pages of this year's Annual Report only reflect data within the County of Bexar. Bexar County encompasses the city of San Antonio and at least a portion of the following cities: Alamo Heights Hill Country Village Shavano Park Balcones Heights Hollywood Park Somerset Castle Hills Kirby Terrell Hills China Grove Leon Valley Universal City Cibolo Live Oak Von Ormy Converse Lytle Windcrest Elmendorf Olmos Park Fair Oaks Ranch Saint Hedwig Grey Forest Schertz Helotes Selma Abbreviations Used BCMEO: Bexar County Medical Examiner's Office ME Staff: Medical Examiner Staff D.A.: District Attorney OOC: Out of County Race W/M: White (Caucasian, including Hispanic), Male W/F: White (Caucasian, including Hispanic), Female B/M: Black, Male B/F: Black, Female O/M: Other (Asian, Native-American, etc.), Male O/F: Other (Asian, Native-American, etc.), Female 6
MANNER OF DEATH Manner 2006 2007 2008 Homicide 165 159 175 Suicide 170 163 172 Accident 657 793 850 Natural 749 813 747 Undetermined 98 121 78 Unclassified 4 8 7 Total 1843 2057 2029 Percent Autopsied, by Manner - 2008 Manner Total Cases Number Autopsied Percent Autopsied Homicide 175 175 100% Suicide 172 134 78% Accident 850 499 59% Natural 747 462 62% Undetermined 78 74 95% Unclassified 7 7 100% Total 2029 1351 67% 7
HOMICIDES BY METHOD Method 2006 2007 2008 Firearms 103 98 121 Sharp Force 16 18 22 Blunt Force 15 20 20 Asphyxia 10 5 2 Excited Delirium 1 4 0 Other 20 14 10 Total 165 159 175 140 120 # of Cases 100 80 60 40 20 2006 2007 2008 0 Firearms Sharp Force Blunt Force Asphyxia Excited Delirium Other Method 8
HOMICIDES BY AGE, RACE/SEX Age (years) 2006 2007 2008 0-5 7 10 8 6-10 2 1 1 11-15 3 3 1 16-19 12 16 18 20-29 61 47 62 30-39 30 34 26 40-49 23 21 29 50-59 16 14 20 60-69 5 4 4 70-79 4 5 4 80-89 1 1 2 90-99 0 0 0 Unk 1 3 0 Total 165 159 175 Race/Sex 2006 2007 2008 W/M 98 97 103 W/F 27 27 37 B/M 31 25 31 B/F 7 7 4 O/M 2 1 0 O/F 0 0 0 Unknown 0 2 0 Total 165 159 175 9
HOMICIDES BY FIREARMS Type of Weapon 2006 2007 2008 Handgun 75 68 71 Centerfire Rifle 4 3 6 Rimfire Rifle 3 1 5 Shotgun 5 8 6 Other/Unknown 16 18 33 Total 103 98 121 Caliber of Handguns 2006 2007 2008.38/.357 14 13 9.22 5 5 1.25 0 1 2.32 6 2 0.380 ACP 2 5 3 9 mm 25 21 20.40 17 12 17.45 ACP 6 3 8 Multiple/Other/Unknown 0 6 11 Total 75 68 71 10
HOMICIDES - DRUGS/ALCOHOL Drugs/Alcohol Analysis 2006 2007 2008 No Tests Performed 4 5 5 Negative for Drugs & Alcohol 67 45 52 Alcohol Only 32 38 33 Drugs Only 36 51 53 Drugs & Alcohol 26 20 32 Total 165 159 175 Alcohol Levels (g/dl) 2006 2007 2008 <.05 7 8 12.05-.099 13 8 12.10-.199 25 28 23.20-.299 10 10 16.30+ 3 4 2 Total 58 58 65 11
CHILD HOMICIDES BY AGE AND METHOD - 2008 Ages 0-17 (years) Age Total Firearms Sharp Force Blunt Force Asphyxia Other Infant (under 1) 2 0 0 1 1 0 1 to 4 6 1 0 5 0 0 5 to 8 0 0 0 0 0 0 9 to 12 1 0 0 0 0 1 13 to 17 7 6 0 0 1 0 Total 16 7 0 6 2 1 *SUDDEN UNEXPLAINED DEATH IN INFANCY Race/Sex 2006 2007 2008 W/M 7 10 18 W/F 3 19 6 B/M 2 0 3 B/F 1 1 2 O/M 0 0 0 O/F 0 0 0 Total 13 30 29 *As of January 1, 2007, the Bexar County Medical Examiner s Office no longer uses the terminology Sudden Infant Death Syndrome (SIDS). Unexplained deaths in infancy are now described with the more accurate term Sudden Unexplained Death in Infancy with appropriate modifiers reflecting sleeping arrangements or other risk factors. 12
SUICIDES BY METHOD, AGE, RACE/SEX Method 2006 2007 2008 Firearms 88 78 94 Drugs/Chemicals 27 24 22 Hanging 39 45 37 Carbon Monoxide 2 1 1 Sharp Force 3 4 3 Other 11 11 15 Total 170 163 172 Age (years) 2006 2007 2008 <15 1 0 1 15-19 15 9 7 20-29 23 36 38 30-39 37 34 29 40-49 37 39 34 50-59 26 18 30 60-69 16 8 22 70-79 10 11 7 80-89 5 8 3 90-99 0 0 1 Total 170 163 172 Race/Sex 2006 2007 2008 W/M 127 118 119 W/F 33 34 37 B/M 6 7 10 B/F 2 0 1 O/M 2 0 4 O/F 0 4 1 Total 170 163 172 13
SUICIDES BY FIREARMS Type of Weapon 2006 2007 2008 Handgun 67 65 74 Centerfire Rifle 1 3 4 Rimfire Rifle 3 2 7 Shotgun 11 8 9 Unknown 6 0 0 Total 88 78 94 Caliber of Handguns 2006 2007 2008.38/.357 20 26 27.22 11 6 9.25 0 7 2.32 9 0 7.380 ACP 3 7 3 9mm 10 9 9.40 6 8 7.45 ACP 4 1 3 Other/Unknown 4 1 7 Total 67 65 74 14
SUICIDES - DRUGS/ALCOHOL Drugs/Alcohol Analysis 2006 2007 2008 No Tests Performed 1 3 13 Negative for Drugs & Alcohol 50 51 42 Alcohol Only 31 18 27 Drugs Only 59 64 59 Drugs & Alcohol 29 27 31 Total 170 163 172 Alcohol Levels (g/dl) 2006 2007 2008 <.05 8 4 7.05-.099 11 6 12.10-.199 24 24 22.20-.299 15 10 15 +.30 2 1 2 Total 60 45 58 15
TEENAGE SUICIDES BY METHOD, RACE/SEX Ages 13-19 (years) Method 2006 2007 2008 Firearms 5 7 3 Hanging 8 2 4 Drugs 2 0 0 Other 1 0 0 Total 16 9 7 Race/Sex 2006 2007 2008 W/M 11 5 2 W/F 3 2 2 B/M 2 1 2 B/F 0 0 0 O/M 0 0 1 O/F 0 1 0 Total 16 9 7 16
ACCIDENTS BY METHOD, RACE/SEX Method 2006 2007 2008 Motor Vehicle Accidents 219 243 254 Fall 202 263 302 Drugs/Chemicals 168 191 215 Fire 21 16 7 Drowning 15 25 16 Other 32 56 55 Total 657 794 849 Race/Sex 2006 2007 2008 W/M 378 476 518 W/F 234 259 292 B/M 27 38 23 B/F 15 18 11 O/M 1 1 2 O/F 2 2 3 Total 657 794 849 *Motor vehicle accidents include the following types of deaths: motor vehicle-driver; motor vehicle-passenger; motor vehicle-pedestrian; motor vehicle-fire; motorcyle/atv; and bicycle deaths. Accidents By Method Motor Vehicle Accidents 1% 2% 6% 30% Fall Drugs/Chemicals Fire 25% Drowning Other 36% 17
ACCIDENTS BY AGE AND METHOD - 2008 Age Method Total (years) MV Drugs/ Asphyxia/ Accidents Fall Chemicals Choking Drowning Fire Other Infant (under 1) 11 1 0 0 9 1 0 0 1 to 4 9 2 1 0 1 4 0 1 5 to 8 2 1 0 0 0 1 0 0 9 to 12 3 3 0 0 0 0 0 0 13 to 16 12 5 2 3 0 1 0 1 17 to 19 31 20 1 7 1 0 0 2 20 to 24 55 27 1 23 0 2 0 2 25 to 29 53 22 0 28 1 1 0 1 30 to 34 36 20 2 11 0 0 0 3 35 to 39 52 13 3 31 2 0 1 2 40 to 44 68 18 4 39 1 1 0 5 45 to 49 52 19 8 21 2 1 0 1 50 to 54 62 22 5 32 1 1 0 1 55 to 59 38 14 9 10 2 0 1 2 60 to 64 39 17 15 5 1 0 0 1 65 to 70 51 17 25 2 2 1 1 3 over 70 275 33 226 3 5 2 4 2 Total 849 254 302 215 28 16 7 27 18
MOTOR VEHICLE ACCIDENTS - DRIVERS Drugs/Alcohol Analysis 2006 2007 2008 No Tests Performed 11 19 15 Negative for Drugs & Alcohol 29 24 39 Alcohol Only 25 19 26 Drugs Only 21 18 16 Drugs & Alcohol 8 10 11 Total 94 90 107 Alcohol Levels (g/dl) 2006 2007 2008 <.05 0 2 2.05-.099 7 1 5.10-.199 17 12 14.20-.299 8 12 15 +.30 1 2 1 Total 33 29 37 Seatbelt Use 2006 2007 2008 Yes 34 39 53 No 32 29 26 Unknown 28 22 28 Total 94 90 107 19
MOTOR VEHICLE ACCIDENTS - PEDESTRIANS Drugs/Alcohol Analysis 2006 2007 2008 No Tests Performed 4 15 3 Negative for Drugs & Alcohol 14 16 20 Alcohol Only 4 6 15 Drugs Only 7 7 10 Drugs & Alcohol 6 2 3 Total 35 46 51 Alcohol Levels (g/dl) 2006 2007 2008 <.05 0 0 1.05-.099 2 1 0.10-.199 5 2 5.20-.299 3 3 7 +.30 0 2 5 Total 10 8 18 20
MOTOR VEHICLE ACCIDENTS Motorcycles and Bicycles (Operator or Driver) Motorcycles Bicycles Drugs/Alcohol Analysis 2006 2007 2008 2006 2007 2008 No Tests Performed 3 5 12 0 4 1 Negative for Drugs & Alcohol 11 8 15 1 0 1 Alcohol Only 6 11 11 0 0 0 Drugs Only 4 8 6 3 0 4 Drugs & Alcohol 5 5 5 0 0 0 Total 29 37 49 4 4 6 Alcohol Levels (g/dl) 2006 2007 2008 2006 2007 2008 <.05 1 2 0 0 0 0.05-.099 0 1 1 0 0 0.10-.199 7 10 10 0 0 0.20-.299 2 3 4 0 0 0 +.30 1 0 1 0 0 0 Total 11 16 16 0 0 0 Helmet Use 2006 2007 2008 2006 2007 2008 Yes 11 10 18 0 0 0 No 12 16 19 0 2 1 Unknown 6 11 12 4 2 5 Total 29 37 49 4 4 6 21
DEATHS DUE TO DRUGS/TOXIC SUBSTANCES 1 Drug/Toxic Substance 2006 2007 2008 Heroin 32 33 58 Cocaine 40 50 36 Heroin/Cocaine 28 14 28 Methamphetamine 11 11 6 Methadone 8 15 12 Other Narcotics 32 31 32 Anti-Depressants/Anti-Psychotic 6 4 3 Mixed Drugs 35 41 43 Ethyl Alcohol 3 6 2 Carbon Monoxide 2 3 3 Other 14 23 20 Total 211 231 243 1 Deaths due to Drugs or Toxic Substances consist of several Manners of Death (Suicide, Accident and Undetermined). 22
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